Brazilian guide to nutrition in bariatric and metabolic surgery.

PURPOSE: Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS: A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS: The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION: We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.

[Not Available]. / Asociación de los indicadores antropométricos y de composición corporal en la predicción de la resistencia a la insulina en pacientes con enfermedad de las arterias coronarias.

Introducción: en los últimos años la importancia de identificar la resistencia a la insulina (RI) en pacientes con enfermedades cardiovasculares isquémicas viene siendo debatida. Métodos alternativos, como los indicadores antropométricos y de composición corporal, han sido señalados como una buena opción y contribuyen para identificar anomalías metabólicas y prevenir complicaciones.Objetivo: asociar indicadores antropométricos y de composición corporal como predictores de la resistencia a la insulina (RI) en pacientes con enfermedad de las arterias coronarias.Métodos: estudio transversal realizado en el hospital de referencia cardiológica de Pernambuco, en el periodo de junio a septiembre de 2014, con pacientes adultos y ancianos hospitalizados, de ambos sexos. Se verificaron los siguientes parámetros: estilo de vida, la presencia del síndrome metabólico (SM) y otras comorbilidades. Se analizó la RI por el cálculo del HOMA-IR. Los pacientes se sometieron a la impedancia bioeléctrica (BIA) y a las verificaciones antropométricas.Resultados: la muestra fue constituida por 75 pacientes con edad media de 63,75 ± 12,43 años, con un 64% de ancianos. Se encontró el diagnóstico de SM en el 65,3% de los pacientes, el 81,3% de sedentarios y el 37,4% con exceso de peso. Se diagnosticó la RI en el 28% de los pacientes. Se observó correlación entre el HOMA-IR y el diámetro abdominal sagital (DAS) (r = 0,476; p = 0,016), el índice de masa corporal (r = 0,233; p = 0,040) y el porcentual de grasa corporal (r = 0,276; p = 0,016).Conclusión: el DAS fue el indicador antropométrico que presentó mejor correlación con la RI en pacientes con enfermedad de las arterias coronarias hospitalizados.

[Lactation and alcohol: clinical and nutritional effects]. / Lactação e álcool: efeitos clínicos e nutricionais.

Researchers have turned their attention to the effects of alcohol consumption on breastfeeding, with significant negative findings concerning both the mother and the newborn. This study is a meta-analysis of the principle research performed in the last decade that was concerned with lactation and alcohol. Results from experimental and human subject research has shown that effects of alcohol include: behavioural changes, reduced milk and luteinising hormone production, with increased fat content, reduced lactose content. Increased lipogenesis and increased activity of lipoprotein and hormone-sensitive lipase, structural alterations in the epithelial cells of the breast and abnormal casein production, reduced oxytocin and prolactin production with subsequent reduced milk ejection, and reduced weight and protein content of the breast. Reduction in food consumption, body weight, growth and development and hepatic glycogen, serum glucose, amino-acids, insulin, glycerol, fatty acids and urea, and an increase in serum acetoacetic acid is seen in newborn children that were breastfed by animals with a high intake of alcohol during pregnancy or the puerperal period. Alcohol consumption during lactation caused a reduction in liver weight and triglyceride, protein, DNA and lipid content, in the newborns. Serum changes included a reduction in protein, triglyceride, cholesterol, fatty acid and glycerol level with an increase in beta-hydroxybutirate levels. Changes also included alterations in the motor system and behaviour. Further studies are needed to determine, with confidence, the minimum level of alcohol consumption that can provoke pathological effects in both the mother and the child.